Emotional wellbeing can be viewed as representing the positive aspects of mental health, such as the feeling of functioning in each of the aspects of one’s life.

There is extensive debate around whether these two definitions are part of the same continuum or two separate domains entirely (e.g. Huppert et al., 2014).

A recent study published in the Journal of the American Academy of Child & Adolescent Psychiatry aimed to address this question by exploring the predictors of mental illness and wellbeing using a large epidemiological sample (Patalay & Fitzsimons, 2016).

‘Mental illness’ and ‘emotional wellbeing’ are often used interchangeably, but are they even part of the same domain?

Methods

12,347 children aged 11 were surveyed from the UK.

This was part of data collected for the Millennium Cohort Study: a mixture of measures given to individuals born between 2000-2002. This was Wave 5 of the study, recorded when the participants were aged 11.

Study participants were a good representation of the UK demographics, including sex, ethnicity and socio-economic background.

Emotional wellbeing: Mental wellbeing was self-rated by the 11 year olds participants. This was a measure previously used in the British Household Panel Study of happiness in six different areas of their life (school, family, friends, school work, appearance and life as a whole). The scores from this questionnaire were aggregated to form a wellbeing score.

Other measures

Also included in the the Millennium Cohort Study were measures of ethnicity, socio-demographic status, cognitive and health factors, family structure, home environment, parent health, social relationships and wider environment (e.g. child perspectives of school connectedness).

Analysis

The correlation between each of the variable outcomes was calculated. Stepwise regression analyses were conducted to see what factors best predicted mental illness and wellbeing.

Results

There was a low correlation (r = .2) between mental illness and wellbeing measure outcomes.

Interestingly, the significant predictors of mental illness scores were different to those that significantly predicted wellbeing outcomes.

Mental illness

47% of the variance of mental illness outcome scores was explained by the predictor variables

The main predictors of outcome were:

Cognitive factors

Home environment factors

Parent health

Social relationships

Mental illness scores were significantly higher for children with:

Communication difficulties

Chronic illnesses

Peer relation problems

Frequent arguments with a parent

Mental illness scores were significantly lower for children with:

High family income

Emotional wellbeing

26% of the variance of wellbeing scores was explained by the predictor variables

The main predictors of outcome were:

Social relationships

The wider environment

The highest individual predictors of wellbeing were:

Perceived school connectedness

Liking school

Peer bullying

Ethnicity was a significant predictor for mental illness but not emotional wellbeing. Black, Asian or ethnic groups other than White predicted lower mental illness scores.

Credit: Praveetha Patalay

Strengths and limitations

This epidemiological study has a large sample size and uses very representative demographics, meaning that the results are more generalisable to the UK population.

One major limitation of comparing the mental illness and wellbeing measures is that they have different reporters. The mental illness measure is parent-reported, whilst the wellbeing measure is self-reported by the young people themselves. The understanding of somebody’s mental experiences will differ between parents and the young people themselves, and it may be that the low correlation between measures can be explained mainly due to reporter differences. However, in a similar study correlating self-reporting mental ill health and perceived quality of life in 13 year olds, correlation scores remained low at r = .22 (Sharpe et al., 2016).

To better investigate this problem, the next Wave of the Millennium Cohort Study conducted later this year will contain self-rated measures of mental illness and depression.

SDQ scores were used to give a measure of ‘mental illness’. However, this measure compiles both externalising disorders (e.g. conduct disorder) with internalising disorders (e.g. depression). It may be the case that whilst externalising disorders do not correlate highly with wellbeing, internalising disorders do correlate more highly. It would be interesting to see analyses measuring the correlation of the internalising disorders score alone with the other predictor measures.

The validity of the measure of wellbeing should be questioned. The original measure asked participants to rate their happiness in six different domains. The definition of wellbeing is not concrete and different questionnaires of wellbeing may not be measuring the same concepts.

The factors that predicted wellbeing in this study are mainly associated with school. The used measure of wellbeing has six questions. Two of these questions are about school, making up a large proportion of the total score. This ‘school-weighted’ measure may be a reason why school factors are more significant predictors for this measure of wellbeing.

One major limitation of this research was that mental illness was measured by asking parents and emotional wellbeing was measured by asking young people.

Summary and conclusions

This excellent study is a broad and in-depth exploration of the predictive factors of mental illness and wellbeing in 11 year olds.

Wellbeing is better predicted by aspects of a child’s social and relationship life, such as peer bullying and perception of school connectedness.

However, mental illness is better predicted by chronic and health conditions, as well as ethnicity.

The low correlation between mental illness and wellbeing outcomes suggests that these are largely distinct but overlapping domains.

The authors write:

Correlates of children’s mental illness and wellbeing are largely distinct, stressing the importance of considering these concepts separately and avoiding their conflation.

Future studies should investigate whether parent-rated measures of mental illness are as accurate as child-rated measures. It would also be interesting to see whether these differences are maintained in further adolescent and adult development.

Lucas is a PhD Researcher at the University of Reading. He is currently researching viable methods of teacher training and education in mental health. Lucas is a London dweller, film and science lover and depression advocate. His main passions are developing early interventions for children and adolescents who may develop mental health disorders, and Star Wars.

I’m a little confused. Surely ethnicity, chronic health can very massively impact connectedness and relationships. Perhaps our interventions are simply not providing enough to help those who society struggles to connect with?

Also confused at why distinct but overlapping isn’t a continuum? You would expect bigger differences between either end?

This is a nice post. It could be used as the starting point of lots of discussions. Here’s one: Does the research method itself (using internal measure of wellbeing and external measure of illness) immediately clarify the difference between the two, and why they are not a continuum? We define mental illness from the outside, yet what people are struggling with is their subjective experience. Your post defines the study as the subject, which wraps the whole thing up! I suspect that in this respect the post may be more excellent than the paper, but I haven’t read the paper yet, so I should do that now.